Provider Demographics
NPI:1215045919
Name:HEINE, CAROL J (OD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:HEINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3700
Mailing Address - Fax:812-234-3565
Practice Address - Street 1:422 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4209
Practice Address - Country:US
Practice Address - Phone:812-242-3700
Practice Address - Fax:812-234-3565
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001834A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089606OtherANTHEM
410031551OtherRAILROAD MCARE PALAMETTO
INP00830676OtherRAILROAD MEDICARE
INP00830676OtherRAILROAD MEDICARE
000000089606OtherANTHEM
410031551OtherRAILROAD MCARE PALAMETTO
T35108Medicare UPIN